Healthcare Provider Details

I. General information

NPI: 1669659009
Provider Name (Legal Business Name): FLORIDA NEUROIMAGING ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 6TH ST S
ST PETERSBURG FL
33701-4814
US

IV. Provider business mailing address

7032 BAYOU WEST AVE
PINELLAS PARK FL
33782-4552
US

V. Phone/Fax

Practice location:
  • Phone: 727-823-1234
  • Fax:
Mailing address:
  • Phone: 727-215-4480
  • Fax: 864-850-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberME92656
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME92656
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME92656
License Number StateFL

VIII. Authorized Official

Name: DR. NASSER RAZACK
Title or Position: OWNER
Credential: MD
Phone: 864-850-1441